Discussing RA Pain During Telehealth Visit

If you’ve gotten into the habit of using telehealth when possible during the COVID-19 pandemic, you may actually make it to your appointments more often.

In a new study presented during ACR Convergence 2020, the annual meeting of the American College of Rheumatology, researchers found that greater telehealth use during the pandemic reduced cancellation rates and no-shows for rheumatology clinics in the MetroHealth System, a large Ohio health system. (The term telehealth is often used interchangeably with the term telemedicine; both refer to delivering health care through technology, such as video/audio services or phone calls.)

The researchers looked at data from an electronic health record system for rheumatology outpatient (meaning, at a doctor’s office or clinic — not a hospital) appointments from January 3 to May 31, 2020, and divided appointments into “canceled,” “no-show,” or “completed” categories. They then divided that data into two 10-week periods — one before the COVID-19 phase (January 3 to March 15) and one during COVID-19 (March 16 to May 31).

In the pre-pandemic phase, patients were only permitted to have visits in person. During the COVID-19 phase, the clinic offered both in-person visits or telemedicine to patients.

There were nearly zero telemedicine appointment cancellations during the COVID-19 phase (one out of 825 scheduled appointments was cancelled), compared to many more in the pre-pandemic phase (527 out of 1,677 scheduled appointments were cancelled).

No-shows also trended down: In the COVID-19 phase, the clinics had only 191 no-shows (121 in-person visits and 70 telehealth appointments). Before that, when only in-person visits were available, there were 220 no-shows.

This led to an increase in completed appointments (1,038 total) during COVID-19 compared to completed in-person appointments before the pandemic (930 total).

The results show that telehealth may be a promising way to ensure patients get the care they need. Based on the findings, MetroHealth’s Division of Rheumatology will aim for 40 percent of future visits to be done through telehealth.

“Although in-person visits cannot always be replaced by phone or video visits, we believe that telemedicine’s potential to increase the accessibility and convenience of health care makes it an essential component to the future of medicine,” the study’s co-author, Reem Alkilany, MD, a rheumatology fellow at MetroHealth, said in a press release.

For instance, some rheumatology visits are routine checkups and are less reliant on a procedural intervention or physical exam. As such, these appointments may be good options for telehealth.

Of course, during the pandemic, telehealth also has the advantage of lowering your exposure to germs and potentially COVID-19.

While doctor’s offices are following all the necessary precautions and are likely quite safe, you should discuss your concerns about whether an in-person visit or telehealth visit is better for your personal situation.

“Many rheumatology patients are already at an increased risk for infection due to immunosuppressive medications and immune system dysfunction related to their diseases,” said Dr. Alkilany. “While in-person visits may place patients at risk for contracting the virus, delaying care can increase the risk for disease flares and the potential need for hospitalization. Telemedicine offered a way for rheumatology patients and providers to connect with one another in place of delayed care or even absence of care.”

There may also be other barriers to accessing in-person care, such as lack of transportation or concerns that transportation may expose you to COVID-19 infection.

Using telemedicine as part of routine clinic visits may improve a patient’s overall appointment adherence and, as a result, their long-term health.

Want Better Virtual Care with Your Rheumatologist?

For personalized advice on getting the most out of your rheumatology telehealth visits, check out our new site eRheum.org.

Alkilany R, et al. Telemedicine Visits During COVID-19 Improved Clinic Show Rates [abstract]. Arthritis & Rheumatology. November 2020. https://acrabstracts.org/abstract/telemedicine-visits-during-covid-19-improved-clinic-show-rates.